Informed decision-making in delivery of dialysis: combining clinical outcomes with sustainability
- PMID: 34987789
- PMCID: PMC8711764
- DOI: 10.1093/ckj/sfab193
Informed decision-making in delivery of dialysis: combining clinical outcomes with sustainability
Abstract
As the prevalence of chronic kidney disease is expected to rise worldwide over the next decades, provision of renal replacement therapy (RRT), will further challenge budgets of all healthcare systems. Most patients today requiring RRT are treated with haemodialysis (HD) therapy and are elderly. This article demonstrates the interdependence of clinical and sustainability criteria that need to be considered to prepare for the future challenges of delivering dialysis to all patients in need. Newer, more sustainable models of high-value care need to be devised, whereby delivery of dialysis is based on value-based healthcare (VBHC) principles, i.e. improving patient outcomes while restricting costs. Essentially, this entails maximizing patient outcomes per amount of money spent or available. To bring such a meaningful change, revised strategies having the involvement of multiple stakeholders (i.e. patients, providers, payers and policymakers) need to be adopted. Although each stakeholder has a vested interest in the value agenda often with conflicting expectations and motivations (or motives) between each other, progress is only achieved if the multiple blocs of the delivery system are advanced as mutually reinforcing entities. Clinical considerations of delivery of dialysis need to be based on the entire patient disease pathway and evidence-based medicine, while the non-clinical sustainability criteria entail, in addition to economics, the societal and ecological implications of HD therapy. We discuss how selection of appropriate modes and features of delivery of HD (e.g. treatment modalities and schedules, selection of consumables, product life cycle assessment) could positively impact decision-making towards value-based renal care. Although the delivery of HD therapy is multifactorial and complex, applying cost-effectiveness analyses for the different HD modalities (conventional in-centre and home HD) can support in guiding payability (balance between clinical value and costs) for health systems. For a resource intensive therapy like HD, concerted and fully integrated care strategies need to be urgently implemented to cope with the global demand and burden of HD therapy.
Keywords: haemodialysis; informed-decision making; sustainability; value-based healthcare.
© The Author(s) 2021. Published by Oxford University Press on behalf of ERA.
Figures






Similar articles
-
The future of Cochrane Neonatal.Early Hum Dev. 2020 Nov;150:105191. doi: 10.1016/j.earlhumdev.2020.105191. Epub 2020 Sep 12. Early Hum Dev. 2020. PMID: 33036834
-
Seeking an optimal renal replacement therapy for the chronic kidney disease epidemic: the case for on-line hemodiafiltration.Contrib Nephrol. 2011;175:170-185. doi: 10.1159/000333636. Epub 2011 Dec 15. Contrib Nephrol. 2011. PMID: 22188699
-
Barriers to successful implementation of care in home haemodialysis (BASIC-HHD):1. Study design, methods and rationale.BMC Nephrol. 2013 Sep 17;14:197. doi: 10.1186/1471-2369-14-197. BMC Nephrol. 2013. PMID: 24044499 Free PMC article. Clinical Trial.
-
Healthcare systems and end-stage renal disease (ESRD) therapies--an international review: costs and reimbursement/funding of ESRD therapies.Nephrol Dial Transplant. 1999;14 Suppl 6:31-41. doi: 10.1093/ndt/14.suppl_6.31. Nephrol Dial Transplant. 1999. PMID: 10528710 Review.
-
End-stage renal care in developing countries: the India experience.Ren Fail. 2004 May;26(3):201-8. doi: 10.1081/jdi-120039516. Ren Fail. 2004. PMID: 15354966 Review.
Cited by
-
Advances in Human-Centered Care to Address Contemporary Unmet Needs in Chronic Dialysis.Int J Nephrol Renovasc Dis. 2024 Mar 20;17:91-104. doi: 10.2147/IJNRD.S387598. eCollection 2024. Int J Nephrol Renovasc Dis. 2024. PMID: 38525412 Free PMC article. Review.
-
Digital health tools in nephrology: A comparative analysis of AI and professional opinions via online polls.Digit Health. 2024 Aug 28;10:20552076241277458. doi: 10.1177/20552076241277458. eCollection 2024 Jan-Dec. Digit Health. 2024. PMID: 39221085 Free PMC article.
-
Peritoneal Dialysis for Potential Kidney Transplant Recipients: Pride or Prejudice?Medicina (Kaunas). 2022 Feb 1;58(2):214. doi: 10.3390/medicina58020214. Medicina (Kaunas). 2022. PMID: 35208541 Free PMC article. Review.
-
Proceedings of a membrane update symposium: advancements, scientific insights, and future trends for dialysis membranes for enhanced clinical outcomes in end stage kidney disease patients.Front Nephrol. 2024 Oct 15;4:1455260. doi: 10.3389/fneph.2024.1455260. eCollection 2024. Front Nephrol. 2024. PMID: 39473870 Free PMC article.
References
-
- Coresh J, Jafar TH. Disparities in worldwide treatment of kidney failure. Lancet 2015; 385: 1926–1928 - PubMed
-
- Liyanage T, Ninomiya T, Jha V et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet 2015; 385: 1975–1982 - PubMed
-
- Wongrakpanich S, Susantitaphong P, Isaranuwatchai S et al. Dialysis therapy and conservative management of advanced chronic kidney disease in the elderly: a systematic review. Nephron 2017; 137: 178–189 - PubMed
Publication types
LinkOut - more resources
Full Text Sources
Research Materials